Implementing YouthCHAT – evaluation and development of an implementation framework

Purpose A high proportion of indigenous Māori, a generally socioeconomically deprived population, live in Northland, New Zealand. Māori youth suffer a high rate of mental ill-health, substance misuse, and other risky behaviours. While evidence demonstrates that early detection and management of these issues leads to long-term positive health outcomes, implementation of systematic screening and intervention is challenging. YouthCHAT is a self-administered digital tool screening young people for mental health concerns and risky health behaviours. Our purpose was to implement YouthCHAT into Northland youth services using an iterative process of implementation, evaluation, and modification, and create a framework for national-level rollout. Approach A bicultural approach combined Kaupapa Māori research and co-design principles to inform implementation and evaluation. Informed by field notes, informal communications plus focus groups, and interviews with end-users, we identified and addressed barriers to uptake of YouthCHAT. Consolidated framework for implementation research and normalisation process theory was theoretical underpinnings of the project. We measured uptake by the number of YouthCHAT screens completed. Discussion It took three years to successfully embed YouthCHAT and implement it into usual practice. A change was needed at all levels, from the individual practitioner to the service team through to the over-arching health system. A bicultural co-design approach and programming remote functionality during coronavirus disease 2019 (COVID-19) lockdown contributed to YouthCHAT's ultimate acceptability and implementation. The cultural context in which an intervention is introduced is often overlooked. This partnership approach may be time-consuming and challenging. However, an intervention will only be adopted where there is local ownership and it is seen as fit for purpose. Our framework addresses the importance of communication and coordination in the acceptance and uptake of an innovation, with ongoing evaluation as an integral part of implementation. It is generalisable to other settings and augments other models such as the consolidated framework for implementation research currently available. Plain language summary The Northland region of New Zealand has a particularly socioeconomically deprived population with a high proportion of indigenous Māori. Māori youth suffer a high rate of mental ill-health, substance misuse, and other risky behaviours. Early detection of these issues means they can be addressed and youth are less likely to have future health and social problems. YouthCHAT is a self-administered digital tool screening young people for mental health concerns and risky health behaviours. We implemented YouthCHAT into Northland youth services using an iterative process of implementation, evaluation, and modification, and created a framework for national-level rollout. A bicultural approach combined Māori research and co-design principles, using information from many sources including focus groups, staff surveys, field notes, and informal communications to inform implementation and evaluation. It took three years to successfully embed YouthCHAT into usual practice. A change was needed at all levels, from the individual practitioner to the service team through to the over-arching health system. Programming remote functionality during COVID-19 lockdown contributed to YouthCHAT's ultimate acceptability and implementation. This bicultural partnership approach may be time-consuming and challenging. However, ultimately an intervention will only be enthusiastically adopted if there is local ownership and it is seen as fit for purpose. Our success is measured by the number of YouthCHAT screens now being completed. Our framework addresses the importance of communication and coordination in the acceptance and uptake of an innovation, with ongoing evaluation as an integral part of implementation. It is generalisable to other settings and augments other models currently available